Toomas SärevConsultant CardiologistNorfolk and Norwich University HospitalHonorary LecturerUniversity of East AngliaNorwich, United Kingdom
Kardiologiska och Hjärtkirurgiska Erfarenheter Från Khartoum
Ingen intressekonfliktImages used in this presentation originate from my own, Dr Lindblom’s, Dr Puntila’s and Emergency’s archives
How Did I Get Involved In This Project ?
Till: Toomas Särev/DS/SLL@SLLFrån: Dan Lindblom/Karolinska/SLLDatum: 2009-10-07 16:06Kopia: [email protected]Ärende: Why not work in Sudan?
Dear Toomas...
You’ve got mail ...
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Why did I do that?
• to work in an International Multilingual, Multicultural Team is enriching, inspiring, challenging and makes you humble
• To test myself
Sudan
Sudan• Population: about 39 400 000
– Khartoum 8 900 000
• BNP: 1 630 USD
• Covers 2 505 813 km²
– six times larger than Sweden
• Estimated life expectancy 57 years
• 62 % of population can read and write
• Expenses of health care 21 USD/capita
• 0,2 physicians/1000 inhabitants
• Most of the inhabitants are followers of Islam (70%)
• Arabic
Emergency NGO
The Organization
• Non-political, neutral and independent humanitarian Non-Governmental Organization established in 1994 in Milan, Italy –under leading of Dr. Gino Strada
• Over 3 200 000 patients treated in 15 countries
• Approximate budget 25 000 000 €/year, with administrative costs of 6%
Gino Strada
Emergency – the mission
• To provide high standard and free of charge medical and surgical assistance to victims of landmines, war and poverty
The Salam Centre forCardiac Surgery
Facilities and Staff• 3 fully equipped OT• 15 ICU beds• 48 beds in Ward–16 sub-ICU beds
• Echocardiography• Lab and Blood Bank• Cath Lab• CT scanner• Out-patient clinics• Guest-house for 50• Compound for the
international staff• Services• Meditation Hall
International staff 60National staff 306
Volume of work April 2007 - March 2011
• Patients triaged 30 692• Cardiological examinations 21 967•Hospital admissions 5 053• Patients admitted 4 051• Patients operated 3 391• Cath Lab procedures 932
Primary diagnosis
• Valvular Heart Disease 72.7 %• Congenital Heart Disease 22.1 %• Ischaemic Heart Disease 3.9 %• Ascending Aorta & AV 0.7 %•Other 0.6 %
Multiple Valve 44 %
Mitral 45 %
Aortic 10 %
Tricuspid < 1 %
Surgery for Valvular Heart Disease
The Salam Centre for Cardiac Surgery
Early complications
• 30-days surgical mortality (91 pt) 2.81 % (”Expected mortality” Euroscore standard >3.7 %)
– most common causes of death•Low Output Syndrome (45 pt) 49%•Multiorgan Failure (17 pt) 19%
• Re-op for bleeding 6.3 %• Late pericardial tamponade 2.5 %• Permanent pacemaker 0.4 %• Mediastinitis 0.001 %
My Personal Input and Experience
Work Profile:• worked six days/week under four months– Friday - The day of Prayer
• Clinical meeting every morning • Clinical work in the Sub-ICU, ward rounds, on-calls–teaching of national staff
• Diagnostic and Interventional Work at the Cath Lab• Support for OT & ICU, opinion requests, TOE’s• Outpatient Clinics–postoperative follow-ups–workflow of patients with coronary artery disease
Cardiological Challenges• management patients with extremely advanced
combined valvular disease combined with advanced pulmonary hypertension–decompensated heart failure very difficult to
manage both pre- and postoperatively• different pattern in hemodynamic response– air conditioned hospital with “low” room temperature
causes vasoconstriction and deterioration– some patients do not develop pulmonary
hypertension and have extremely fragile hemodynamics
• arterial spasms very common (radial, coronary)
Surgical Challenges• mitral valve repair/plasty in rheumatic MVR • multiple valve operations– above two especially challenging in young patients and
children
• re-operations in emergency situation for thrombosis of valve prosthesis (especially in gravid women)
• extremely advanced pulmonary hypertension with RV involvement
• surgery of cachectic patients• patients suffering of congenital problems with late
presentation (in adulthood)–adults with TOF (Tetralogy of Fallot’)
Challenges for the Future(my own subjective vision)
• to develop Locally Tailored Guidelines
• to improve infrastructure with modern solutions for managing hospital information – PACS archive, electronic records etc.– research database
• to make Long-term follow-up better
Clinical MeetingSalam Centre
Ward Round, Sub-ICUSalam Centre
Operating TheatreSalam Centre
Cath LabGE Innova 2000Salam Centre
Cath Lab TeamSalam Centre
Most used combination of vasocactive support, Sub-ICUSalam Centre
Outpatient ClinicETTSalam Centre
Relaxing moment atMeroe PyramidsSudan
Wildlife - DaytimeSalam Centre
Wildlife - NighttimeSalam Centre
lessons learned:
generating and optimizing local resources
Complex health projects are feasible in Africa
with clinically outstanding results
Do You Need More Information?
Email me:
Visit:
www.emergency.itwww.salamcentre.emergency.it
"You've got to find what you love, and that is as true for work as it is for lovers..... Don't settle.
As with all matters of the heart, you'll know when you find it."
Steve Jobs - Founder and CEO of Apple
Thank you